{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:19:42Z","timestamp":1793330382767,"version":"4.5.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec id=\"ab-noi250081-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>In patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO), the benefit of intravenous thrombolysis (IVT) administered beyond 4.5 hours from the last time known well before endovascular therapy (EVT) is uncertain. Recently, the TIMELESS trial failed to demonstrate a benefit of IVT in this setting, but this trial focused on patients directly admitted to comprehensive stroke centers (CSCs) with fast access to EVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250081-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the efficacy and safety of IVT initiated beyond 4.5 hours in patients with AIS-LVO initially admitted to primary stroke centers (PSCs) and subsequently transferred to a CSC for EVT, allowing substantial time for the IVT to take effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250081-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study was conducted between January 2020 and December 2024, with 3-month follow-up, at 20 French PSCs. All consecutive patients with AIS-LVO admitted beyond 4.5 hours from the last time they were known well in the PSC and subsequently transferred to a CSC for EVT, with or without IVT administered prior to transfer, were eligible for inclusion. Data analysis was performed between May 2025 and July 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250081-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was the 3-month modified Rankin Scale score, analyzed in the ordinal approach. Propensity score with overlap weighting (PSOW) balanced covariates between patients treated with IVT vs those without.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250081-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 584 patients were included, among whom 309 patients (52.9%) were female. Median (IQR) age was 71 (61-81) years, median (IQR) baseline National Institutes of Health Stroke scale score was 15 (10-19), median (IQR) time from last known well to PSC imaging was 10.5 (6.9-14.0) hours, and 232 patients (39.7%) received IVT before transfer. Advanced brain imaging (magnetic resonance imaging or computed tomography [CT] with CT-perfusion) was performed at the PSC in 544 patients (93.2%). IVT use before transfer was independently associated with a shift toward better 3-month outcomes (PSOW\u2013common odds ratio [OR], 1.97; 95% CI, 1.33-2.92;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.001) and higher odds of recanalization during transfer (PSOW-OR, 8.69; 95% CI, 3.16-23.87;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) compared with those without. The rate of any intracerebral hemorrhage and symptomatic intracerebral hemorrhage were similar between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250081-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this multicenter cohort study, IVT initiated beyond 4.5 hours prior to interhospital transfer for EVT was associated with higher rates of recanalization during transfer and improved 3-month functional outcomes, without safety concerns. These findings offer encouraging support for clinical trials evaluating IVT in the late time window before interhospital transfer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2025.4712","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T16:00:22Z","timestamp":1764604822000},"page":"60","source":"Crossref","is-referenced-by-count":11,"title":["Intravenous Thrombolysis Use in the Late Time Window Before Interhospital Transfer for Thrombectomy"],"prefix":"10.1001","volume":"83","author":[{"given":"Pierre","family":"Seners","sequence":"first","affiliation":[{"name":"Neurology Department, H\u00f4pital Fondation A. de Rothschild, Paris, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Team Turc, Paris, France"},{"name":"Stroke-Link F-CRIN Research Network, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour","family":"Nehme","sequence":"additional","affiliation":[{"name":"Neurology Department, Centre Hospitalier de Gonesse, Gonesse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Ter Schiphorst","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Team Turc, Paris, France"},{"name":"Neurology Department, CHRU Gui de Chauliac, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9rique","family":"Charbonneau","sequence":"additional","affiliation":[{"name":"Imaging Department, H\u00f4pital Fondation A. de Rothschild, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Chausson","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Team Turc, Paris, France"},{"name":"Neurology Department, Sud-Francilien Hospital, Corbeil-Essonnes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Belley","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, Mignot Hospital, Versailles, France"},{"name":"Versailles Saint Quentin en Yvelines and Paris Saclay University, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Wacongne","sequence":"additional","affiliation":[{"name":"Neurology Department, CHU Nimes, Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olfa","family":"Kaaouana","sequence":"additional","affiliation":[{"name":"Neurology Department, CH Valenciennes, Valenciennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Henry","sequence":"additional","affiliation":[{"name":"Neurology Department, 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